It was meant to work with a Sega Saturn or pre-Dual Shock PS1 controller; joystick support in the DOS verison seems like an afterthought & is kind of crap. You're probably best off with something like a 4-button Gravis Gamepad and just keeping your pinky fingers above the keyboard for extra actions.

That said, if anyone manages to play through this game with a steering wheel or HOTAS setup, I want to see the video. Badly.

I played all the way through with a Microsoft SideWinder Freestyle Pro using the D-pad rather than the tilt, and it was a miserable experience. I really enjoyed the game, but I was a complete spaz with that particular gamepad. I think it took like 30-40 tries to get through just one of the timing areas.